Lower-Dose Mepivacaine Plus Fentanyl May Improve Spinal Anesthesia for Knee Arthroscopy.

Background: Previous work indicates that 30 mg isobaric mepivacaine 1.5% plus 10 μg fentanyl produces reliable anesthesia for knee arthroscopy with a more rapid recovery profile than 45 mg mepivacaine.

Questions/purposes: This randomized controlled trial compared plain mepivacaine to three reduced doses of mepivacaine with 10 μg fentanyl for spinal anesthesia.

Technique for margin convergence in rotator cuff repair.

The purpose of the present study is to describe the technique of margin convergence for U-shaped rotator cuff tears and report the clinical outcomes and ultrasonography with a minimum of 2 years follow-up. Three hundred eleven patients with a rotator cuff tear were prospectively enrolled in a registry at one institution. Inclusion criteria included any patient undergoing arthroscopic margin convergence for a rotator cuff tear.

Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II--prognostic factors for clinical and radiographic outcomes.

Background: A rotator cuff registry was established to prospectively evaluate the effectiveness of all-arthroscopic repairs. The purpose of this study is to report prognostic factors for successful clinical and radiographic outcomes at 5 years.

Methods: One-hundred ninety-three patients underwent all-arthroscopic rotator cuff repairs.

Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part I--functional outcomes and radiographic healing rates.

Background: A rotator cuff registry was established to prospectively evaluate the effectiveness of all-arthroscopic repairs. This study reports those results at 5 years.

Materials And Methods: The study enrolled 193 patients who underwent all-arthroscopic rotator cuff repairs.

Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months' follow-up.

Background: Preventing anatomic failure after rotator cuff repair (RCR) remains a challenge. Augmentation with a surgical mesh may permanently reinforce the repair and decrease failure rates. The purpose of this study is to assess the postoperative outcomes of open RCR augmented with a novel reticulated polycarbonate polyurethane patch.

Biomechanical analysis of an ovine rotator cuff repair via porous patch augmentation in a chronic rupture model.

Background: Rotator cuff repair is a commonly performed procedure, but many of these repairs fail in the postoperative term. Despite advances in surgical methods to optimize the repair, failure rates still persist clinically, thereby suggesting the need for novel mechanical or biological augmentation strategies. Nonresorbable implants provide an appealing approach because patch materials may confer acute mechanical stability and act as a conductive scaffold for tissue ingrowth at the site of the tendon insertion.

Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears.

Recent studies have reported that massive rotator cuff tears do not heal as predictably as, and may have diminished clinical outcomes compared with, smaller rotator cuff tears. An improved understanding of the biologic degeneration and the biomechanical alterations of massive rotator cuff tears should provide better strategies to optimize outcomes. The approach to patients with massive rotator cuff tears requires careful assessment of the patient and the extent of rotator cuff degeneration to determine the appropriate treatment.

Arthroscopic rotator cuff repair: prospective evaluation with sequential ultrasonography.

Background: Recent studies have demonstrated predictable healing after arthroscopic rotator cuff repair at a single time point, but few studies have evaluated tendon healing over time.

Hypothesis: Rotator cuff tears that are intact on ultrasound at 1 time point will remain intact, and clinical results will improve regardless of healing status.

Study Design: Cohort study; Level of evidence, 3.

Prospective analysis of arthroscopic rotator cuff repair: subgroup analysis.

Background: The rotator cuff registry was established to evaluate prospectively the effectiveness of arthroscopic rotator cuff repair. The purpose of the present study is to report the preliminary data at the 1- and 2-year time point and perform subgroup analysis to identify factors that may affect outcome.

Methods: A total of 193 patients underwent all-arthroscopic repair of a rotator cuff tear and met the inclusion criteria and 127 (65.

Rotator cuff tears: pathology and repair.

By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. The factors contributing to cuff disease can be divided into those extrinsic to the rotator cuff (most notably impingement) and those intrinsic to the cuff (age-related degeneration, hypovascularity and inflammation amongst others). In an era of emerging biologic interventions, our interventions are increasingly being modulated by our understanding of these core processes, many of which remain uncertain today.

Traumatic bilateral knee dislocations, unilateral hip dislocation, and contralateral humeral amputation: a case report.

Bilateral traumatic knee dislocations are a rarity. We report a case of bilateral traumatic knee dislocations with concomitant right hip dislocation and complete traumatic amputation of the left, nondominant upper extremity at the level of the proximal one-third of the humerus. Angiograms revealed no evidence of popliteal artery injury.

Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome.

The purpose of this study was to identify potential predictors of function and tendon healing after arthroscopic rotator cuff repair that will enable the orthopaedic surgeon to determine which patients can expect a successful outcome. Between 2003 and 2005, the Arthroscopic Rotator Cuff Registry was established to collect demographic, intraoperative, functional outcome, and ultrasound data prospectively on all patients who underwent primary arthroscopic rotator cuff repair. At total of 193 patients met the study criteria, and 127 (65.

Rotator cuff degeneration: etiology and pathogenesis.

By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. How we intervene is governed by our understanding of the pathological mechanisms in cuff disease. These factors can be divided into those extrinsic to the rotator cuff (impingement, demographic factors) and those intrinsic to the cuff (age-related degeneration, hypovascularity, inflammation, and oxidative stress, among others).

Biomechanical comparison of 3 suture anchor configurations for repair of type II SLAP lesions.

Purpose: Our purpose was to compare 3 commonly used suture anchor configurations for repair of type II SLAP lesions.

Methods: Biomechanical testing was performed on 3 groups of 7 cadaveric shoulders by use of an optical linear strain measurement system. Standardized type II SLAP lesions were created and repaired via 3 suture anchor configurations: (1) a single simple suture anterior to the biceps; (2) two simple sutures, one anterior and one posterior to the biceps; and (3) a single mattress suture through the biceps anchor.

Innovations in the management of displaced proximal humerus fractures.

The management of displaced proximal humerus fractures has evolved toward humeral head preservation, with treatment decisions based on careful assessment of vascular status, bone quality, fracture pattern, degree of displacement, and patient age and activity level. The AO/ASIF fracture classification is helpful in guiding treatment and in stratifying the risk for associated disruption of the humeral head blood supply. Nonsurgical treatment consists of sling immobilization.

Biomechanical fixation in arthroscopic rotator cuff repair.

Rotator cuff repair remains a challenging and rapidly evolving field. Several recent studies have shown that arthroscopic repair yields functional results similar to those of mini-open and open procedures, with all of the benefits of minimally invasive surgery. However, the "best" repair construct remains relatively unknown, with wide variations in surgeon preference and conflicting evidence in the literature.

Biomechanical evaluation of a rotator cuff defect model augmented with a bioresorbable scaffold in goats.

A bioresorbable patch used for augmentation of rotator cuff repair was evaluated to determine if it would increase strength of cuff repairs associated with tendon defects and also show histologic incorporation over time. Forty goats underwent rotator cuff repairs of the infraspinatus tendon bilaterally. Tendons were detached and a defect was created prior to repair.

Biocompatibility of a polymer patch for rotator cuff repair.

Both mechanical and biological factors influence the high re-tear rate after rotator cuff repair. Mechanical factors have largely been addressed by the introduction of better implants and modification of suture configuration, but further improvements are needed to address the often poor tissue quality of the degenerated rotator cuff tendons. Current biological solutions provide only short-term reinforcement and have been associated with pseudo-infectious reactions.

The two-step maneuver for closed reduction of inferior glenohumeral dislocation (luxatio erecta to anterior dislocation to reduction).

The 2-step closed reduction maneuver was developed to aid in the rarely encountered inferior shoulder dislocation. The maneuver converts the humeral head from an inferior dislocation to an anterior dislocation and then reduces the humeral head into the glenoid. The operator places one hand on the shaft of the humerus and the other hand on the medial condyle.

Biomechanical evaluation of the relation between number of suture anchors and strength of the bone-tendon interface in a goat rotator cuff model.

Purpose: The effect of contact area between tendon and bone on ultimate pullout strength of a repaired tendon is not known. The purpose of this study was to test whether the strength of a healed bone-tendon interface is related to the amount of tendon that is in contact with bone at the time of repair.

Methods: A total of 20 mature goats underwent bilateral open rotator cuff repair of the infraspinatus tendon.

Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up.

Purpose: Surgical treatment of isolated posterior cruciate ligament (PCL) injuries is controversial. The purpose of this retrospective study was to evaluate the surgical outcomes of PCL reconstruction. Two techniques were compared, the traditional endoscopic and the more recent tibial inlay, to determine if the inlay technique yielded more stable reconstructions.

Traumatic shoulder dislocation in the adolescent athlete: advances in surgical treatment.

Purpose Of Review: The shoulder joint has the greatest range of motion of any joint in the body and as a result is particularly susceptible to dislocation and subluxation. Recurrent instability is a common complication after traumatic shoulder dislocation in young people, with rates as high as 100% in skeletally immature patients and 96% in for adolescents. Treatment for shoulder dislocation has traditionally involved immobilization followed by a rehabilitation program.